TY - JOUR
T1 - Sleep apnea in patients hospitalized with acute ischemic stroke
T2 - Underrecognition and associated clinical outcomes
AU - Festic, Nura
AU - Alejos, David
AU - Bansal, Vikas
AU - Mooney, Lesia
AU - Fredrickson, Paul A.
AU - Castillo, Pablo R.
AU - Festic, Emir
N1 - Funding Information:
AIS, acute ischemic stroke BMI, body mass index CAD, coronary artery disease CHF, congestive heart failure CI, confidence interval CPAP, continuous positive airway pressure DM, diabetes mellitus GCS, Glasgow coma scale HL, hyperlipidemia HTN, hypertension IQR, interquartile range NIHSS, National Institutes of Health Stroke Scale mRS, modified Rankin scale OR, odds ratio OSA, obstructive sleep apnea PAP, positive airway pressure TIA, transient ischemic attack
Funding Information:
Baseline characteristics and clinical variables were obtained from the patient’s electronic chart at the time of hospital admission for AIS and at the first posthospitalization follow-up, as applicable. The demographic data included age, sex, race, and body mass index. The principal variable of interest was the diagnosis or the clinical suspicion for sleep apnea. The diagnosis was suggested based on the abnormal polysom-nography results or clinical chart notes indicating history of OSA, whereas the clinical suspicion for OSA was based on the abnormal overnight oximetry findings, consistent with sleep-disordered breathing. Where possible, these reports were used to classify sleep apnea (obstructive, mixed, central, or indeterminate). Outpatient compliance with positive airway pressure (PAP) therapy was abstracted based on the last available sleep medicine note prior to the hospitalization or documentation of self-reported compliance at the time of the admission for AIS. The respiratory notes were used to collect data on the hospital PAP treatment. The National Institutes of Health Stroke Scale (NIHSS) was recorded from the initial neurological assessment and the lowest recorded value of Glasgow coma scale (the worst GCS) during the hospitalization was abstracted. Other clinical variables included cardiovascular comorbidities: hypertension (HTN), coronary artery disease (CAD), congestive heart failure (CHF), diabetes mellitus (DM) and hyperlipidemia (HL).
PY - 2018/1/15
Y1 - 2018/1/15
N2 - Study Objectives: To evaluate clinical recognition of sleep apnea and related outcomes in patients hospitalized with acute ischemic stroke. Methods: A retrospective study of all patients hospitalized with acute ischemic stroke from April 2008 to December 2014. The primary predictor and outcome variables were sleep apnea and hospital mortality, respectively. Secondary outcomes were mechanical ventilation, hospital length of stay, and the survivor's functional level by the modified Rankin scale. A sensitivity multivariate regression analysis included the propensity score for cardiovascular comorbidities and sleep apnea. Results: Of 989 patients, 190 (19%) were considered to have sleep apnea. Only 42 patients (22%) received any treatment for sleep apnea during the hospital stay. Despite higher prevalence of cardiovascular comorbidities, the patients with sleep apnea had lower hospital mortality, 1% versus 5.6% in patients without sleep apnea (odds ratio [OR] 0.18; 95% confidence interval [CI], 0.03-0.58, P = .002). Only the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow coma scale (GCS) were significant predictors of adjusted hospital mortality (OR 1.06, 95% CI 1.01-1.11, P = .01 and OR 0.61, 95% CI 0.51-0.69, P ≤ .001, respectively). A composite clinical propensity score for sleep apnea and cardiovascular comorbidities was significantly associated with decreased mortality, independent to either NIHSS (OR 0.11, 95% CI 0.017-0.71; P = .02) or GCS (OR 0.07, 95% CI 0.01-0.52; P = .01). Conclusions: Prevalence of sleep apnea in our study was low, likely because of clinical underrecognition. Despite having more cardiovascular disease, the patients with acute stroke and sleep apnea had less severe neurological injury and lower unadjusted mortality than those without a history of sleep apnea.
AB - Study Objectives: To evaluate clinical recognition of sleep apnea and related outcomes in patients hospitalized with acute ischemic stroke. Methods: A retrospective study of all patients hospitalized with acute ischemic stroke from April 2008 to December 2014. The primary predictor and outcome variables were sleep apnea and hospital mortality, respectively. Secondary outcomes were mechanical ventilation, hospital length of stay, and the survivor's functional level by the modified Rankin scale. A sensitivity multivariate regression analysis included the propensity score for cardiovascular comorbidities and sleep apnea. Results: Of 989 patients, 190 (19%) were considered to have sleep apnea. Only 42 patients (22%) received any treatment for sleep apnea during the hospital stay. Despite higher prevalence of cardiovascular comorbidities, the patients with sleep apnea had lower hospital mortality, 1% versus 5.6% in patients without sleep apnea (odds ratio [OR] 0.18; 95% confidence interval [CI], 0.03-0.58, P = .002). Only the National Institutes of Health Stroke Scale (NIHSS) and the Glasgow coma scale (GCS) were significant predictors of adjusted hospital mortality (OR 1.06, 95% CI 1.01-1.11, P = .01 and OR 0.61, 95% CI 0.51-0.69, P ≤ .001, respectively). A composite clinical propensity score for sleep apnea and cardiovascular comorbidities was significantly associated with decreased mortality, independent to either NIHSS (OR 0.11, 95% CI 0.017-0.71; P = .02) or GCS (OR 0.07, 95% CI 0.01-0.52; P = .01). Conclusions: Prevalence of sleep apnea in our study was low, likely because of clinical underrecognition. Despite having more cardiovascular disease, the patients with acute stroke and sleep apnea had less severe neurological injury and lower unadjusted mortality than those without a history of sleep apnea.
KW - Acute ischemic stroke
KW - Ischemic preconditioning
KW - Mortality
KW - Obstructive sleep apnea
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U2 - 10.5664/jcsm.6884
DO - 10.5664/jcsm.6884
M3 - Article
C2 - 29198297
AN - SCOPUS:85040765795
SN - 1550-9389
VL - 14
SP - 75
EP - 80
JO - Journal of Clinical Sleep Medicine
JF - Journal of Clinical Sleep Medicine
IS - 1
ER -